A case requiring extraction, sinus lift, bone grafting and implant placement all together

[Initial panoramic X-ray] The area circled in red is the site requiring treatment

The patient came in after a tooth root-treated long ago at another clinic fractured because of secondary decay; only the root now remains. Had more of the crown portion survived, one could have built a post to reinforce it and attempted a crown. With only the root left, extraction becomes unavoidable.

Initial CT scan

Initial intraoral photograph

This case required extraction, a sinus lift, bone grafting and implant placement all together. Carrying those steps out separately would take a very long time indeed.

I prefer approaches that keep the number of procedures and anaesthetics to a minimum. In a case like this, extraction, sinus lift, bone graft and implant placement can all be completed under one anaesthetic in a single procedure taking roughly fifteen to twenty minutes. Because everything is done at once, the overall treatment period is dramatically shorter.

It is also done flaplessly, without incising the gum, so as the post-operative photograph shows there is no incision line to see. Recovery is therefore quick and daily life is barely affected — the only suturing is a single stitch on each side to keep the extraction socket from opening.

Because it is flapless, bleeding had already stopped by the end of surgery, so the patient did not even need to bite on gauze. In any oral surgery — implant placement, wisdom tooth removal — the less the surrounding tissue is disturbed, the better the outcome. Opening the gum widely certainly gives the surgeon a better view and an easier time, but from the patient's point of view a minimal incision is better in every respect.